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Clinical analysis of thoracoscopic lobectomy: a report of 40 cases.

Yun LI ; Jun WANG ; Jun LIU ; Jian-feng LI ; Guan-chao JIANG ; Hui ZHAO ; Fan YANG ; Yan-guo LIU ; Zu-li ZHOU ; Liang BU

Chinese Journal of Surgery.2008;46(6):405-407.

OBJECTIVETo review the technology of completely thoracoscopic lobectomy procedures.

METHODSFrom September 2006 to July 2007, 40 patients (23 male and 17 female) underwent completely thoracoscopic lobectomy. The median age was 59.5-years-old, with a range from 24 to 79-years-old. The lobectomy was completed through 3 incision in the 5th, 8th and 7th intercostal space. The procedures were similar with conventional open lobectomy.

RESULTSAll procedure were carried out safely, including lung cancer (n = 34), lymphoma(n = 1), pulmonary cyst (n = 1), middle lobe syndrome (n = 1) , bronchiectasis (n = 2) and renal carcinoma metastasis to lung (n = 1). There were no operative mortality or serious complications. There was one patient opposed to open thoracotomy because of the mediastinal lymph nodes metastasis. The average surgical duration was 206 min (range from 60 to 300 min). The average blood loss was 221 ml (range from 100 to 400 ml) with no blood transfusion required. The average length of stay was 8.9 d. No recurrence and metastasis was observed in a follow-up range from 1 to 10 months except one patient with adenocarcinoma occurred metastasis of tumor 3 months postoperation.

CONCLUSIONThe completely thoracoscopic lobectomy is a safe and feasible surgical procedure compared with conventional open lobectomy for selected patients.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Lung Diseases ; surgery ; Male ; Middle Aged ; Pneumonectomy ; methods ; Thoracoscopy ; Treatment Outcome

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Injuries after lobectomy: a prospective randomized comparison of video-assisted thoracoscopic surgery and mini-thoracotomy.

Hao LONG ; Zhi-chao LIN ; Dong-rong SITU

Chinese Journal of Surgery.2008;46(6):401-404.

OBJECTIVETo compare the differences of injuries and recovery between video-assisted thoracoscopic surgery (VATS) and mini-thoracotomy (MT) in patients with clinical early stage non-small cell lung cancer (NSCLC) after lobectomy.

METHODSFrom March 2004 to December 2006, 47 consecutive patients with early stage NSCLC with a diameter of tumor less than 6 cm were recruited and randomized to VATS group and MT group. Incision length, duration of operation and intraoperative blood loss were recorded. Postoperative pain was assessed using a visual analogue scale before operation and daily for the first 7 days after operation. The serum levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured by cytometric bead array before operation and at 4, 24, and 48 h after operation. Karnofsky performance status (KPS) was assessed before operation and daily for the first 7 days after operation.

RESULTSIncision length was (6.0 +/- 0. 9) cm in the VATS group and (12.5 +/- 1.5) cm in the MT group. There was no significant difference in duration of operation and intraoperative blood loss between the VATS group and the MT group. Postoperative pain was significantly less in the VATS group in the 5th to 7th day postoperatively (P < 0.05). There was no significant difference of serum concentrations of IL-6 and IL-10 between the VATS group and the MT group at 4, 24, and 48 h after operation. KPS score was significantly higher in the VATS group on 2nd to 7th day postoperatively (P < 0.05).

CONCLUSIONCompared with MT, VATS for lobectomy has less postoperative pain, faster recovery, but can't reduce postoperative release of cytokines.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; surgery ; Double-Blind Method ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; prevention & control ; Pneumonectomy ; methods ; Prospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

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Study on clinicopathological correlations between metabolic syndrome and colorectal carcinoma.

Zhan-Long SHEN ; Shan WANG ; Ying-Jiang YE ; Mu-Jun YIN ; Xiao-Dong YANG ; Ke-Wei JIANG ; Yan LIU

Chinese Journal of Surgery.2008;46(7):537-539.

OBJECTIVETo explore the clinicopathological relationship between metabolic syndrome (MS) and colorectal cancer.

METHODSThe clinical data of 507 cases of colorectal cancer (colorectal cancer group) and 277 cases of nontumorous diseases (control group) treated from January 2002 to March 2007 were collected to set up the database. The patients with colorectal carcinoma were divided into two groups according to the presence of MS: MS group and non-MS group. Some clinicopathological factors were analyzed and compared between the two groups, such as age, gender, blood pressure, tumor family history, hypertension and diabetes mellitus history, body mass index (BMI), glucose (GLU), triglyceride (TG), cholesterol (CHO), high density lipoprotein (HDL), lactate dehydrogenase (LDH), uric acid (UA), carcinoembryonic antigen (CEA) , CA19-9, the tumor position, pathological stage, and liver metastasis.

RESULTSThe morbidity rate of metabolic syndrome in the colorectal cancer group was significantly higher than that in control group. The rate of liver metastasis and tumor recurrence in the MS group was significantly higher than that in the non-MS group.

CONCLUSIONTo understand the relationship between MS and colorectal cancer is important for reducing the incidence of MS and colorectal cancer and the recurrence of the tumor and live metastasis.

Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; pathology ; Female ; Follow-Up Studies ; Humans ; Male ; Metabolic Syndrome ; complications ; Middle Aged ; Prognosis

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Influence of gender on development and prognosis of atherosclerosis obliterans.

Bin CHEN ; Zhi-Hui DONG ; Wei-Guo FU ; Zhen-Yu SHI ; Ting ZHU

Chinese Journal of Surgery.2008;46(7):534-536.

OBJECTIVETo evaluate the influence of gender on the development and prognosis of atherosclerosis obliterans (ASO).

METHODSEight hundred and forty-two patients with ASO were treated from January 2000 to February 2007. The clinical data were retrospectively collected. And the influence of gender on the development and prognosis of ASO was investigated.

RESULTSAmong the 842 patients, 661 were male and 181 were female. The ratio of male to female was 3.65 : 1.00, and the ratio decreased with increasing age. The mean age of male and female patients were (71.7 +/- 9.0) years and (75.7 +/- 6.8) years, respectively. Significantly more iliac lesions occurred in male patients than in female, while female patients experienced more infrainguinal lesions. The coexistence rate of diabetes and amputation rate were significantly higher in female patients than in male (46.4%/24.7% and 16.0%/9.1%, respectively).

CONCLUSIONThe female patients with ASO appear to have poorer prognosis than the male, despite their lower incidence of ASO.

Adult ; Aged ; Aged, 80 and over ; Arteriosclerosis Obliterans ; epidemiology ; therapy ; Female ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Prognosis ; Sex Factors

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Clinical experience of BVS5000 left ventricular assist devices in heart failure patients.

Sheng-Shou HU ; Han-Song SUN ; Xin-Jin LUO ; Ping LIU ; Yan ZHANG ; Wei-Guo MA

Chinese Journal of Surgery.2008;46(7):531-533.

OBJECTIVETo explore the experience of Abiomed BVS5000 as a mean of left ventricular support on clinical treatment for severe heart failure patients.

METHODSFrom February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 as a left ventricular assist device. The average age was (55.2 +/- 9.6) years old (range from 39 to 68 years old). Mean body surface area was (1.76 +/- 0.1) m2 (range from 1.6 to 1.9 m2). Devices were inserted for post-cardiotomy shock after coronary artery bypass grafting in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrial through bovine jugular vein were used in 7 patients. In this way, the device could be taken off without resternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.

RESULTSThe average duration of support was (8.8 +/- 11.2) d (range from 3 to 43 d), with support flow rate of 3.8 to 4.5 L/min. There were 9 patients (75%) weaned from support and 8 patients (67%) discharged from the hospital Four patients (33%) were dead. The most common morbidity was adverse neurologic events. There was no statistic difference between modified and routine method on average BVS5000 support duration, assisted flow rate, mechanical ventilation duration, stay of intensive care unit and thoracic drainage.

CONCLUSIONSThe Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. With using modified cannulating method, the weaning procedure can be effectively simplified.

Adult ; Aged ; Heart Failure ; surgery ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Retrospective Studies

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Surgical treatment of aortic coarctation with intracardiac anomaly in infants and toddlers.

Qi-Bin YU ; Xiang-Dong SHEN ; Shou-Jun LI ; Zhong-Dong HUA ; Jin-Ping LIU ; Ying-Long LIU ; Sheng-Shou HU

Chinese Journal of Surgery.2008;46(7):528-530.

OBJECTIVETo review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers.

METHODSFrom January 2000 to December 2006, 84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment. Mean age of the patients was 13.5 months, with a range from 1 month to 3 years. Mean body weight was 7.3 kg, with a range from 3.3 to 15 kg. Twelve patients complicated with complex intracardiac anomaly. Seventy-two patients complicated with ventricular septal defect and other simple anomaly. Twenty-one patients had hypoplasia of the aortic arch. Sixty-two patients had one-stage repair. Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients. Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients. Twenty-two patients had staged repair. Operational techniques for aortic coarctation include 42 patients of patch aortoplasty, 30 patients of resection and end-to-end anastomosis, 6 patients of subclavian flap aortoplasty, 3 patients of vascular bypass, and 1 patient of balloon dilation. In all 49 patients of one-stage operation through median sternotomy, selective cerebral perfusion was used in 43 patients, deep hypothermia low flow was applied in 4 patients, deep hypothermia circulatory arrest was performed in 2 patients.

RESULTSThere were 8 hospital deaths. The mortality is 9.5%. Among 8 deaths, 3 patients were misdiagnosed.

CONCLUSIONSSurgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers. One-stage repair through median sternotomy can be applied to most of the patients. Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.

Aortic Coarctation ; complications ; surgery ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

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The contribution for the diagnosis of the tumor-like polypoid lesions of the gallbladder by SELDI-TOF-MS.

Feng-Ming LUAN ; Chun-Lin GE ; Ning MA ; Yong-Zhe LI ; Chao-Jun HU ; Ning LI

Chinese Journal of Surgery.2008;46(7):525-527.

OBJECTIVETo detect the serum specific proteins in tumor-like polypoid lesions of the gallbladder patients and establish diagnostic model.

METHODSSurface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS) technique and WCX Magnetic Beads were used to detect the serum proteomic patterns of 23 patients with tumor-like PLG, 21 patients with non tumor-like PLG and 26 normal persons. Biomarker Wizard and Biomarker Patterns Software were used in combination to analyze the data.

RESULTSPreliminary screening out 22 representative specific proteins for the diagnosis of the tumor-like PLG. Analysis system under the conditions set selected 3 specific proteins to establish diagnostic model for the tumor-like PLG. The sensitivity and specificity of the model for the diagnosis of the tumor-like PLG were 100% and 89.4%, respectively.

CONCLUSIONSELDI-TOF-MS technique can select specific protein of the tumor-like PLG, and establish diagnostic model of the tumor-like PLG.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Blood Proteins ; analysis ; Female ; Gallbladder Neoplasms ; diagnosis ; Humans ; Male ; Middle Aged ; Polyps ; diagnosis ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

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The diagnosis and surgical management for patients with variants of hepatic arteries in the procedure of pancreaticoduodenectomy.

Hong-Qiao GAO ; Yin-Mo YANG ; Yan ZHUANG ; Wen-Han WU ; Wei-Min WANG ; Yuan-Lian WAN

Chinese Journal of Surgery.2008;46(7):522-524.

OBJECTIVETo study the principle and surgical managements for the patients with anatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy (PD).

METHODSOne hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively. Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.

RESULTSHepatic arterial variants were found intraoperatively in 20 cases of all 176 patients. Accessory right heptic artery, replaced right heptic artery and common heptic artery arising from the superior mesenteric artery (SMA) were present in 9 (5.1%), 5 (2.8%), 4 (2.3%) cases respectively,and replaced right heptic artery coming from the gastroduodenal artery was present in 2 cases (2.9%). All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging. Most of the variant arteries were dissected intact intraoperatively except 2 cases with accessory right heptic artery arising from SMA.

CONCLUSIONSPerforming CT scan preoperatively, especially CTA,is effective to diagnose these disorders. Skillful surgical techniques can manage the anatomic variants safely.

Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Radiography ; Retrospective Studies

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The in vitro observational investigation of antibiotic coating on implants.

Shao-Liang LI ; Yi LU ; Da-Fu CHEN ; Man-Yi WANG

Chinese Journal of Surgery.2008;46(7):518-521.

OBJECTIVESTo investigate the characteristics of antibiotic poly (D, L-lactide) (PDLLA) coating of implants, including its quantity, mechanical stability, sterility and antibiotic release in vitro.

METHODSThe weight of the total coating mass was determined with an electronic semimicro balance before and after coating. Thickness of the coating was documented by scanning electronic microscopy. The stability and the loss of coating mass after implantation and extraction into the intramedullary canal was measured by electronic semimicro balance and the regularity and possible damage of the coating was examined by scanning electronic microscopy. Sterility of the coating procedure was tested by bacteria incubation. A group of coated implants were incubated in PBS to test the coating decrease and the release of gentamicin at different time points.

RESULTSThe quantification of the total coating mass was (7.2 +/- 0.9) mg and the thickness of coating was (13.5 +/- 1.7) microm. After explantation of the coated implants from the tibia medullary, the mean loss of coating mass was (3.5 +/- 1.3)%. Scanning electronic microscopy confirmed no defects of the coating layer extending to the metallic surface in any implant. None of the tested samples presented bacterial growth after incubation on blood agar and tryptic soy broth. The PDLLA depicted a weight reduction of about 6.4% after 6 weeks. Within the first 4 h, the release of gentamicin experienced an initial peak period, then a constant and gradual release was found for at least 6 weeks.

CONCLUSIONSThe antibiotic PDLLA coating on implants can meet the demands of the mechanical stability and sterility, and gentamicin releases quickly in the first hour and the release can last at least 6 weeks. These characteristics undoubtedly justify the feasibility of the coating usage in clinics.

Absorbable Implants ; Anti-Bacterial Agents ; Coated Materials, Biocompatible ; Drug Carriers ; Gentamicins ; In Vitro Techniques ; Internal Fixators ; Materials Testing ; Polyesters

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Clinical analysis of 73 cases of macrodactyly.

Jing-Heng WU ; Guang-Lei TIAN ; Jun-Hui ZHAO ; Chun LI ; You-Le ZHANG ; Yong-Wei PAN

Chinese Journal of Surgery.2008;46(7):514-517.

OBJECTIVETo analyze the clinical characteristics of 73 cases of macrodactyly.

METHODSReview the incidence, distribution, characteristic, X-rays, pathogenesis and treatment of involved digits on the base of the clinical documents of 73 macrodactyly which were treated from 1965 to 2006. Twenty-eight cases had been followed-up.

RESULTSUnilateral involved 71 cases, bilateral involved 2 cases. In upper deformities, the most involved digit was the index finger, followed by thumb and middle finger enlargement. In lower deformities, the second toes were affected more. There were 12 cases of static macrodactyly, which were all presented at or soon after birth. Sixty-one cases were progressive macrodactyly: 39 cases presented at birth; 17 cases occurred at about 2 years old; 5 cases were found after age 2. Thirty-seven cases of progressive type presented digital deviation; 3 cases associated with syndactyly; 16 cases complicated with thenar eminence hypertrophy; 8 cases of multiple-digit involved combined with palm and forearm hyperplasia.

CONCLUSIONSMacrodactyly in hand has a preference for the median nerve territory, mainly involving index, thumb and middle finger. Pedal macrodactyly prefers medial plantar nerve territory, the second toe is the most commonly affected. The progressive macrodactyly is more common than static. It may present at birth and combine with syndactyly, digital deviation, thenar eminence hypertrophy, palm and forearm hyperplasia.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Fingers ; abnormalities ; Follow-Up Studies ; Foot Deformities, Congenital ; surgery ; Hand Deformities, Congenital ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Toes ; abnormalities ; Treatment Outcome

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